Several activities are included in this program. One activity involves a collaboration with the Diabetes Center of Excellence (DCOE) at Phoenix Indian Medical Center (PIMC). We collected and analyzed data from a quality improvement project in which nurse case managers were empowered to adjust antihyperglycemic medications in patients with diabetes to more rapidly optimize glycemic control in a system that does not have sufficient capacity for primary care providers to meet its patient care needs. A manuscript regarding this aspect of the project has been accepted for publication. We have also collaborated with PIMC to develop a protocol for a clinical trial to examine the impact of an intensive lifestyle intervention, delivered in a group care setting, on weight gain and glycemia in pregnancy and on birth weight. We hope to have all approvals completed and begin collecting data under this protocol during FY 2010. We have begun a project with the Phoenix Indian Medical Center and Joslin Vision Network to determine factors responsible for successful implementation of a telemedicine program to identify patients with diabetic retinopathy within the Indian Health Service.